The Pharmaceutical Journal
Vol 273 No 7329 p843
11 December 2004

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Topiramate improves quality of life for alcoholics

POEM series

Clinical question Can topiramate help improve the quality of life for alcoholics?

Bottom line In addition to reducing alcohol consumption, in actively drinking adults with alcoholism, topiramate (Topamax) is more effective than placebo in improving overall well-being and life satisfaction for up to three months. This study lasted only 12 weeks, so the long-term health consequences and safety of topiramate treatment for alcoholism remain uncertain.

Synopsis In actively drinking adult alcoholics, topiramate is more effective than placebo in reducing alcohol consumption. To determine whether topiramate also improves psychosocial functioning, the investigators randomly assigned (uncertain allocation concealment) alcoholics to receive topiramate or matching placebo. Topiramate dosing started at 25mg daily and progressively increased over two months to 300mg daily. Eligible patients were aged 21 to 65 years and met DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders — fourth edition) criteria for alcohol dependence. All patients concurrently received brief behavioural treatment to enhance medication compliance. Outcomes were self-reported using various psychosocial evaluation questionnaires. An intention-to-treat analysis indicated that topiramate statistically improved the odds of overall well-being and life satisfaction compared with placebo. No serious adverse events occurred in either treatment group. Since this study only lasted 12 weeks, however, no long-term data on persistent abstinence or improved health outcomes are reported. The authors report that 16 per cent of randomised patients were lost to follow-up at 12 weeks.

Level of evidence 1b- (randomised controlled trial with a single result with a wide confidence interval)

Reference Johnson BA, Ait-Daoud N, Akhtar FZ, Ma JZ. Oral topiramate reduces the consequences of drinking and improves the quality of life of alcohol-dependent individuals. Arch Gen Psychiatry 2004;61:905-12

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